帕瑞昔布对腹腔镜胆囊切除术后全麻苏醒期应激反应的影响

目的探讨帕瑞昔布对腹腔镜胆囊切除术后全麻苏醒期应激反应的影响。方法择期在全麻下行腹腔镜胆囊切除术患者40例，随机分为芬太尼组（F组）和帕瑞昔布组（P组），每组20例。所有患者均予丙泊酚、瑞芬太尼、顺阿曲库铵和七氟烷维持麻醉。皮肤缝合时，F组静注芬太尼0．1mg，P组静注帕瑞昔布钠40mg。记录拔管前5rain、拔管时、拔管后5min、10min和15min的MAP、HR、SpO2；记录拔管时Riker镇静躁动评分（SAS）和拔管后15min、30min、1h、2h的视觉模拟评分（VAS）；以酶联免疫吸附测定法检测拔管后1min的血浆肾上腺素、去甲肾上腺素和皮质醇的含量；记录拔管时间和气管拔管并发症发生率。结果与F组比较，P组各观测时间点MAP、HR、VAS和SAS均降低，拔管时间缩短，血浆。肾上腺素、去甲肾上腺素和皮质醇的浓度降低，拔管并发症发生率降低（P〈0．05），两组SpO2比较差异无统计学意义。结论帕瑞昔布可有效抑制腹腔镜胆囊切除术后瑞芬太尼全麻苏醒期应激反应。

Effects of parecoxib on stress response in patients undergoing laparoscopic cholecystectomy during recovery period of general anesthesia

Objective To study the effects of parecoxib on the stress response during recovery period of general anesthesia with remifentanil. Methods Forty patients who were scheduled to undergo laparoscopic cholecystomy were randomly divided into pareeoxib group （group P） and fentanyl group （group F）; 20 patients in each growp. Anesthesia was equally maintained with propofol, remifentanil, cisatracurium and sevoflurane in all patients. Pareeoxib sodium 40 mg was intravenously administered in group P when beginning to sew up the incision, while fentanyl 0.1 mg was intravenously administered in group F. MAP, HR and SpO2 were recorded at the following time points： 5 min before tracheal extubation, immediately after tracheal extubation, 5 rain, 10 rain and 15 rain after tracheal extutation. Sedation-agitation scale （SAS） were recorded immediately after tracheal extubation. VAS was recorded at 15 rain, 30 min,1 h and 2 h after tracheal extubation. Venous blood samples were collected 1 rain after tracheal extubation for determination of the contents of epinephrine, norepinephrine, and cortisol. Tracheal extubation time and complications rate were recorded. Results MAP, HR, VAS, SAS, and tracheal extubation complications rate were lower in group P than that in group F 6~ 〈 0.05）. Tracheal extubation time was shorter in group P than in group F （P 〈 0.05）. The serum contents of epinephrine, norepinephrine, and cortisol were lower in group P than in group F （P 〈 0.05）. No difference was found in SpO/between the two groups. Conclusion Intravenous administration of parecoxib can effectively inhibit the stress response in patients undergoing laparoscopic cholecystectomy during recovery period of general anesthesia with remifentanil.